sustain the programs that are critical to investing in the next generation, whether it is education or science, without finding ways to control the growth of entitlement spending more than the affordable care act? >> we have quite a democratic shift happening. it is happening for the next 25 years. many people would like to live forever, but are not going to, even though we are going to try. we have 10,000 seniors every day coming into medicare. we have to contain the rate of growth and costs. we have to understand those are saying is we are promising to take care of. can we make sure the health delivery system is more efficient? yes, we can. i have talked about some of my proposals to do that. we should demand more accountability on that. we should have beneficiaries and patients participate not by denying them care and benefits, but by being healthier. taking the recommendations, following innovations and not doing too much doctor shopping. eating right and exercising. you could also have lousy teams. it is not like you are in control of all of this -- you could also have lousy genes. we are